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American Journal of Medical Genetics 82:442 (1999)
Letter to the Editor
Clinical Differences Between North African and
Iraqi Jews With Familial Mediterranean Fever
To the Editor:
Pras and colleagues [1998], in this Journal, recently
compared the severity of familial Mediterranean fever
(FMF) between North African and Iraqi Jews. They
describe a more severe disease in the North African
patients manifested by an earlier age of onset, an increase in severity and frequency of the joint involvement, a higher incidence of erysipelas-like erythema,
and a higher dose of colchicine required to control the
symptoms. However, they failed to point out that similar findings were published by the FMF group of the
Hadassah University Hospital in Jerusalem [Levy et
al., 1980] some 18 years ago.
We reported that the North African patients manifested an increased familial incidence, earlier onset of
symptoms, and a higher frequency of arthritis. We suggested at the time that the immune response of North
African patients differed from that of subjects of other
ethnic origins. Additional study has shown that autoimmune mechanisms do not play a major role in the
pathogenesis of the FMF. Recently, several mutations
of the gene causing the disease have been mapped and
cloned [French FMF Consortium, 1997; International
*Correspondence to: Micha Levy M.D., Hadassah University
Hospital, Jerusalem, Israel 91120.
Received 6 August 1998; Accepted 9 November 1998
© 1999 Wiley-Liss, Inc.
FMF Consortium, 1997]. Allelic heterogeneity could
well explain the inter-ethnic variation in the clinical
manifestations of this disease.
French FMF Consortium. 1997. A candidate gene for familial Mediterranean fever. Nat Genet 17:25–31.
International FMF Consortium. 1997. Ancient missense mutations in a
new member of the RoRet gene family are likely to cause familial Mediterranean fever. Cell 90:797–807.
Levy M, Ehrenfeld M, Levo Y, Fischel R, Zlotnick A, Eliakim M. 1980.
Circulating immune complexes in recurrent polyserositis (familial
Mediterranean fever, periodic disease). J Rheumatol 7:886–890.
Pras E, Livneh A, Balow JE, Pras E, Kastner DL, Pras M, Langevitz P.
1998. Clinical differences between North African and Iraqi Jews with
familial Mediterranean fever. Am J Med Genet 75:216–219.
Michael Ehrenfeld
Sheba Medical Center
Tel Hashomer, Israel
Micha Levy*
Hadassah University Hospital
Jerusalem, Israel
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